Folks, Boehringer-Ingelheim has decided to stop marketing the 5 day Spiriva Handihaler and replace it with a 5 -day Spiriva Respimat 2.5 mcg/actuation strength.  The cost of the newer 5 day respimat is lower than the Handihaler, and the Respimat achieves better lung exposure than the Handihaler.   The 30 day Spiriva Respimat inhaler is still available in 2 strengths, 1.25 mcg/actuation (FDA approved for asthma) and 2.5 mcg/actuation (FDA approved for COPD), so patients could come in on either strength, but the 2.5 mcg/act. strength will be more commonly used.  Dose in PI for all these Spiriva inhalers is 2 inhalations once daily. We will be only stocking the 5 day 2.5 mcg/actuation inhaler, so please note interchange from the 1.25 mcg/act to the 2.5 mcg/act strength is just one inhalation daily to provide same drug dose.   For a while, you may see patients still coming in on Sprivia Handihaler or physicians prescribing the Handihaler.  P and T has approved an automatic interchange from the lower strength Respimat and the Handihaler to the 2.5 mcg/act. product.  See attached document.  The lower strength, 30 day Respimat and the Handihaler will be non-formulary.  For any product or dosage changes in peds, contact MD, tiotropium use in peds is rare.